Indications and contraindications

Contraindication to procedures :
1.due to radiation
2.due to contrast medium
3.due to techniques
1.due to radiation:
**radiation effect on human:
1-hereditary >> offspring
2-somatic >>a- stochastic(the effect is all or none)
b-non-stochastic(skin erythema and cataracts)
**Stochastic effect, or "chance effect" is one classification of radiation effects that
refers to the random, statistical nature of the damage. In contrast to the
deterministic effect, severity is independent of dose. Only the probability of an
effect increases with dose.
2.due to contrast media:
1-proven or suspected hypersensitivity to iodine
2-previous adverse reaction to contrast media
3-asthma or significant allergic history
4.heart disease: failure and arrhythmias
5.infants and small children
6.hepatic failure
7.moderate or severe impairment of renal function
8-myelomatosis, multiple myeloma.
9.poor hydration
10-sickle cell anemia
11.thyrotoxicosis
12-pregnancy :a possible teratogenic that hasnt been confirmed.

3.due to technique:
1.skin sepsis at the injection site
2.specific contraindications thatll be discussed to each procedure.

_______________
indication of gastrografin:
1-suspected perforation
2-meconium ileus
3.in ct to distinguish bowel from other structure
4.low osmolar contrast medium can be used if theres aspration probability.

comps: pul.edema if aspirated, hypovolemia in children, allergic reaction due to

absorption of C.M, ileus.
*Barium swallow :
indications:
1-dysphagia
2-pain
3-assessment of TEF (non-ionic CM)
4-assessment at the site of perforation
NO CONTRAINDICATIONS.
*barium meal:
Indications :
1-dyspepsia
2-weight loss
3-upper abdominal mass
4-GI bleeding
5-partial obstruction
6-assessment at the site of perforation
Contraindications ( complete large bowel obstruction)
*Barium follow through:
indications:
1-pain
2-diarrhea
3-bleeding
4-partial obstruction
5-abdominal mass
6-failed small bowel enema
Contraindications : 1-small bowel perforation 2-complete obstruction
*Small bowel enema :
indication and contraindication same as barium follow through
Barium enema:
indications:
1.change in bowel habit
2.pain
3-mass
4-obstruction
5-melena
Absolute contraincations :
1-Toxia megacolon

2-pseudomembraneous colitis
3-rectal biopsy within the previous week (if by rigid sigmoidoscopy,flexible isnt
contraindicated)
Relative contraindications:
1-incompplete bowel preparation
2-recent barium meal
*Instant barium enema:
indications to see the extent and severity of mucosal lesions in UC.
contraindication:
1-toxic megacolon
2-rectal biopsy within the previous week
3-long standing UC
4-crohns colitis
loopogram
sinogram
*therapeutic water soluble CM enema in meconium ileus:
diagnostic barium enema is performed priot to this procedure to exclude other
forms of distal intestinal obstruction.
contraindication :
1-perforation
2-volvouls
*enema reduction of intussusceptions:
contraindications :
peritonitis and perforation
advanced intestinal obs.
children older than 4 years.
*Oral cholecystography:
indications:
demonstrate suspected pathology in the gallbladder, CBD, cmmon hepatic duct
contraindication:
1-sever hepatorenal disease
2-acute cholecystitis
3-dehydration
4-previous cholecystectomy
5-intravenous cholangiogram within the previous week
6-the examination is unlikely to be successful when serum bilirubin >34mmol\l
*intravenous cholangiography:

indications:
1-further assessment of the non-funtioning gallbladder on O.C.G
2-post cholecystectomy with recurrent symptoms of biliart tree disease
3-preoperative to exclude CBD stones when the gallbladder contains stones.
7-to demonstrate the CBD when the OCG is normal.
Contraindication:
1-severe hepatorenal disease
2-OCG within the previous week
*intraoperative cholangiogram:
indications:
during cholecystectomy or bile duct surgery to avoid surgical exploration of the
CBD.
NO CONTRAINDICATIONS
*post-operative t-tube cholangiography :
indications:
to exclude biliary stones when intraoperative study not performed, or when its
results are not satisfactory.
NO CONTRAINDICATIONS
*E.R.C.P :
INDICATIONS :
1-investigation of extrahepatic biliary tree obstruction
2-post-cholecystectomy syndrome.
3-investigation of diffuse biliary disease(sclerosing cholangitis)
4-pancreatic disease.
contraindications:
1.H.B.s.Ag positive and AIDS
2-esophageal obstruction, varices and pyloric stenosis.
3-prevous gastric surgery
4-acute pancreatitis
5-pancreatic pseudocyst
6-sever cardiorespiratory disease
7-when glucagon or buscopan is contraindicated.

radiological procedures in urinary tract:

**I.V.U:
indications:
suspected urinary tract pathology.
contraindicated :
general contraindications to water soluble C.M
dehydration is contraindicated in :
1-renal failure
2-myeloma
3-infancy
**pediatric excretion urography
**MCUG:
indications :
1-VUR
2-study of the urethra during micturation
3-abnormalities of the bladder
4-stress incontinence
5-recurrent UTIs
contraindicated in acute UTI
ascending urethrography:
indications :
1-stricture
2-urethral tears
3-congenital abnormality
4-periurethral or prostatic abscess
5-fistulla or false passage
contraindicated in acute UTI and recent instrumentation
**retrograde uretropyelography:
indications:
1-demonstration of the site, length , lower limit and if possible nature of obstructive
lesion
2-demonstration of the pelvicalyceal system after un-satisfactory excretion urogram
contraindicated in acute UTI

**percutaneous renal puncture:

indications :
1-renal cyst puncture:
indications :
1-indeterminate mass
2-inconclusive CT-US
3-cystwall calcification
4-unexplained hematuria with an apparent cyst
5-unexplained fever with cyst
6-to relieve local symptoms attributable to cyst
2-antoigrade pyelography:
1-when other modalities fail to delinate the cause and the level of obstruction
2-when retrograde study failed or not possible
3-prior to or as a part of percutaneous nephrostomy
contraindications:
1-contraindication of water soluble CM
2-bleeding diathesis
3-possibilty of renal hydatid cyst
**percutaneous nephrolithotomy:
indications :
1-removal of calculi
2-disintegration of large renal calculi
contraindications uncontrolled bleeding diathesis
**radiological procedure in respiratory system:
Branchography:
indications :
1-bronchiectasis
2-demonstration of the site and extent of bronchial obstruction
contraindications:
1-acute Respiratory infection
2-poor respiratory reserve
**radiological procedures Of lacrimal system:
darcocystography:
indication :
epiphora to demonstrate the site and degree of obstruction.
epiphora(overflow of tears onto th face)
NO CONTRAINDICATIONS

**procedure in salivary glands:

sialography:
indications:
1-pain
2-swelling
contraindications (acute infection)

GOOD LUCK ALL

AHMAD MATARNEH